Enzymatic assay for urine lactose in the assessment of recent intravenous abuse of buprenorphine.

Urine samples were analyzed for lactose to investigate if elevated lactose concentrations indicate recent (< 48 hours) intravenous abuse of substances containing lactose as an excipient. Elevated lactose levels were found in samples given by patients who had recently injected substances intravenously, verified by fresh injection marks. Urine lactose assay can support clinical and toxicological findings when assessing substance abuse.

Opioid abuse and hospitalization rates in patients with schizophrenia.

BACKGROUND: Substance abuse worsens the course of schizophrenia, but it is not known whether or not there are differences between specific substances concerning their association with the hospitalizations of patients with schizophrenia. AIMS: The primary aims of this study were to examine the possible associations between amphetamine, cannabis, and opioid abuse, and the risk of hospitalizations among patients with schizophrenia. METHODS: The study population consisted of 146 patients with ICD-defined schizophrenia from two different geographical sites in Finland, and it included both inpatients and outpatients. Data were collected retrospectively from the patients' medical files. Substance abuse was defined as either harmful use or dependence according to ICD-10. RESULTS: The cumulative prevalence of substance abuse was 10.9% (16/146) for cannabis, 8.9% (13/146) for amphetamine, and 4.1% (6/146) for opioids. Among patients with schizophrenia and abuse of any substance, the number of hospitalizations was about 1.5-fold when compared to those without substance abuse. The incidence rate ratio for hospitalizations was 2.9 (95% CI 2.47-3.63) for opioids, 2.0 (1.71-2.41) for amphetamine, and 1.6 (1.33-1.84) for cannabis, when compared with no abuse of each substance. The risk of hospitalizations was significantly higher for opioids when compared with amphetamine (p < 0.001) or cannabis (p < 0.001). CONCLUSIONS: Harmful use or dependence of opioids among patients with schizophrenia is associated with significantly higher risk of hospitalizations than either harmful use or dependence of amphetamine or cannabis.

Serotonin transporter polymorphism as a predictor for escitalopram treatment of major depressive disorder comorbid with alcohol dependence.

The aim of this study was to determine whether the serotonin transporter gene polymorphism (5-HTTLPR) is associated with the treatment outcomes of escitalopram for patients with comorbid major depression and alcohol dependence. Eighty treatment-seeking patients were randomly assigned to either receive 20mg of escitalopram or a control of 20mg of the non-serotonergically acting memantine. Depression was measured by the Montgomery-Asberg Depression Rating Scale (MADRS) and alcoholism by the Alcohol Use Disorders Identification Test (AUDIT). Twenty-nine participants in each treatment group completed the study, and from those DNA was given by 27 in the escitalopram group and 21 in the memantine group. In the escitalopram group linear regression showed that LL genotype predicted greater decrease in MADRS scores compared with the SS/SL genotypes (p=0.04) after a 3month treatment period. Moreover, each L allele associated with MADRS score decrease by 15% (p=0.04) in the escitalopram group. In the memantine group, however, no association between LL genotype and MADRS decrease was detected. AUDIT decrease was not associated with the 5-HTTLPR genotype for either medication. This is the first study in the treatment of depression in dual diagnosis patients to report a significant association between outcomes with escitalopram and the 5-HTTLPR gene polymorphism.

Age at onset of first depressive episode as a predictor for escitalopram treatment of major depression comorbid with alcohol dependence.

The aim of this study was to determine predictors of the response to escitalopram, a selective serotonin re-uptake inhibitor antidepressant and memantine, a non-competitive glutamate NMDA receptor blocker, for the treatment of major depression comorbid with alcohol dependence. Eighty alcohol dependent treatment-seeking adult patients with comorbid major depressive disorder were randomized to receive either memantine 20 mg or escitalopram 20 mg for 26 weeks. In both treatment groups, depression was reduced significantly. Comparisons were made between patients in remission (final Montgomery-Asberg Depression Rating Scale (MADRS)

Treatment of alcohol dependence in patients with co-morbid major depressive disorder--predictors for the outcomes with memantine and escitalopram medication.

BACKGROUND: Alcohol dependence comorbid with major depressive disorder poses a major challenge in the clinical setting. The results in the treatment with selective serotonin re-uptake inhibitors have been conflicting. Thus, we compared in alcohol-dependent patients with co-morbid major depressive disorder the selective serotonin re-uptake inhibitor escitalopram to a compound that acts on different transporter system and may reduce craving, the glutamate receptor antagonist memantine. METHODS: Eighty alcohol-dependent patients comorbid with major depressive disorder in municipal alcohol clinics were randomized 1:1 to receive memantine 20 mg or escitalopram 20 mg in a double-blind manner. During the 26-week study period patients continued their routine treatment at the clinics. Abstinence was not required but encouraged. The patients attended visits weekly during the first month, and then at 3 and at 6 months. Outcome measures were Alcohol Use Disorders Identification Test (AUDIT), Obsessive Compulsive Drinking Scale (OCDS) and Drinking Diary. RESULTS: The completion rate was high in both groups, especially among the patients who had been abstinent at the beginning of the study. However, among those patients who were not abstinent at baseline, 47% in both groups discontinued the study. Numbers of abstinent days were high in both groups throughout the study. Alcohol consumption measured by the AUDIT QF (quantity-frequency) score was significantly reduced in both groups, as was the craving for alcohol measured by the OCDS. Early age at first alcohol intoxication predicted poor treatment outcomes in patients treated with escitalopram, and the same was seen with the early onset of the first depressive episode. The same predictive effects were not found in patients treated with memantine. CONCLUSION: Our results indicate that both memantine and escitalopram are useful adjunct medications for the treatment of alcohol dependence co-morbid with major depression. Memantine was at least as effective with regard to drinking as escitalopram. We believe that a direct comparison of memantine, with the commonly used escitalopram, can provide useful information for clinicians on the treatment of alcohol dependency co-morbid with MDD.

Double-blind, randomized comparison of memantine and escitalopram for the treatment of major depressive disorder comorbid with alcohol dependence.

OBJECTIVE: The aim of the study was to evaluate possible new treatments for major depressive disorder in patients with comorbid alcohol dependence in a municipal alcohol treatment unit. The efficacy of memantine, a noncompetitive glutamate N-methyl-D-aspartate (NMDA)-receptor blocker used for the treatment of moderate to severe Alzheimer's disease, was compared with that of escitalopram, a selective serotonin reuptake inhibitor antidepressant. METHOD: Eighty alcohol-dependent outpatients with major depressive disorder (DSM-IV criteria) seeking treatment from municipal alcohol treatment clinics in Helsinki, Finland, were randomly assigned 1:1 to receive memantine 20 mg/day or escitalopram 20 mg/day. During the study period, patients continued their routine treatment at the clinics. Abstinence was not required. Concomitant interventions or imposed treatment goals were not offered by the study physician. The patients returned to the treatment clinics at weeks 1, 2, 4, 12, and 26 for data collection and for medication checking and dispensing. Outcome measures were the Montgomery-Asberg Depression Rating Scale (MADRS) and Beck Depression Inventory-II for depression, Hamilton Rating Scale for Anxiety (HAM-A) and Beck Anxiety Inventory for anxiety, Consortium to Establish a Registry for Alzheimer's Disease test battery for cognitive functions, and Social and Occupational Functioning Assessment Scale for social and occupational functions and quality-of-life measures. Twenty-nine patients in each group completed the study. All primary and secondary outcome statistical analyses were performed by an independent source for intent-to-treat populations, which included all patients randomly assigned to treatment. The study was conducted from December 2004 to May 2006. RESULTS: Both treatments significantly reduced the baseline level of depression and anxiety according to MADRS and HAM-A, which were the primary measures (p < .0001). There was no significant difference between the memantine and escitalopram groups. Assessed cognitive functioning scores were primarily within the normative range and were unchanged in both groups. Quality-of-life outcomes equally improved in both treatment groups. CONCLUSIONS: These data provide new evidence for the safety and potential efficacy of memantine and escitalopram for major depressive disorder in patients with comorbid alcohol dependence. CLINICAL TRIALS REGISTRATION: ClinicalTrials.gov identifier NCT00368862.